FOR THE MEDICAL PRACTITIONER
General Surgery
doi: 10.25005/2074-0581-2024-26-4-674-684
RETROSPECTIVE ANALYSIS OF THE SURGICAL TREATMENT OUTCOMES FOR DIFFUSE PERITONITIS

E.E. CHEPURNYKH1,2, N.I. AYUSHINOVA1,3, E.G. GRIGORIEV1,3, I.A. SHURYGINA1

1Irkutsk Scientific Centre of Surgery and Traumatology, Irkutsk, Russian Federation
2Department of Intermediate-Level Surgery, Irkutsk State Medical University, Irkutsk, Russian Federation
3Department of Advanced-Level Surgery, Irkutsk State Medical University, Irkutsk, Russian Federation

Objective: To analyze surgical treatment outcomes for patients with GP and to identify unfavorable outcome predictors.

Methods: A retrospective study was conducted on 31 medical records of inpatients diagnosed with secondary GP of variable etiology and treated at the Irkutsk Regional Clinical Hospital, Russia. The severity of the patients' conditions was assessed using the Acute Physiology, Chronic Health Evaluation (APACHE) II and the Sequential Organ Failure Assessment (SOFA) scoring systems. Additionally, the severity of peritonitis was evaluated using the Mannheim Peritonitis Index (MPI). Simultaneously, the severity of enteral insufficiency syndrome (EIS) was assessed using the scale proposed Yu.M. Gain et al.

Results: The most common causes of peritonitis were perforated gastric and duodenal ulcers and adhesive intestinal obstruction observed in 22.6% and 19.4% of cases, respectively. The average number of relaparotomies performed was 4.5 [3; 7]. The postoperative mortality rate was 29%. Patients had an average length of hospital stay of 41.5 days [24; 76]. The average APACHE II and SOFA scores were 19 [14; 22] and 3.5 [2; 8], respectively. The severity of EIS in patients during their first operation was scored at 3.7 [3.05; 4.6]. The number of staged relaparotomies with peritoneal lavage was found to be dependent on the severity of EIS (r<sub>s</sub>=0.58), which directly impacted the outcome of the GP (r<sub>s</sub>=0.61). It was established that significant factors in predicting surgical treatment outcomes include the hospital patient's health status, as assessed by the APACHE and SOFA scores, and the severity of peritonitis evaluated according to the MPI.

Conclusion: When predicting the outcome of surgical treatment for GP, it is essential to consider the severity of the patient's condition, the extent of the involvement, and the severity of EIS. By evaluating these factors in a coordinated manner, we can optimize surgical strategies and enhance treatment outcomes for this group of patients

Keywords: Secondary generalized peritonitis, relaparotomy, enteral insufficiency syndrome, severity of the condition, Mannheim peritonitis index.

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Authors' information:

Chepurnykh Elena Evgenievna,
Candidate of Medical Sciences, Academic Secretary, Irkutsk Scientific Centre of Surgery and Traumatology; Associate Professor at the Department of Intermediate-Level Surgery, Irkutsk State Medical University
Researcher ID: B-7280-2017
Scopus ID: 57189622130
ORCID ID: 0000-0002-3197-4276
SPIN: 7650-2129
Author ID: 805452
E-mail: chepurnikh.ee@yandex.ru

Ayushinova Natalia Ilyinichna,
Doctor of Medical Sciences, Senior Researcher at the Scientific Department of Clinical Surgery, Irkutsk Scientific Centre of Surgery and Traumatology; Professor at the Department of Advanced-Level Surgery, Irkutsk State Medical University
Researcher ID: B-7280-2017
Scopus ID: 57189622130
ORCID ID: 0000-0002-5200-3962
SPIN: 7650-2129
Author ID: 805452
Е-mail: katnatlove@mail.ru

Grigoriev Evgeniy Georgievich,
Corresponding Member of the RAS, Doctor of Medical Sciences, Full Professor, Scientific Advisor, Irkutsk Scientific Centre of Surgery and Traumatology; Head of the Department of Advanced-Level Surgery, Irkutsk State Medical University
Researcher ID: B-7280-2017
Scopus ID: 57189622130
ORCID ID: 0000-0002-5082-7028
SPIN: 7650-2129
Author ID: 805452
Е-mail: egg@iokb.ru

Shurygina Irina Aleksandrovna,
Doctor of Medical Sciences, Professor of the RAS, Deputy Director for Science, Head of Laboratory of Cellular Technologies and Regeneration Medicine, Irkutsk Scientific Centre of Surgery and Traumatology
Researcher ID: B-7280-2017
Scopus ID: 57189622130
ORCID ID: 0000-0003-3980-050X
SPIN: 7650-2129
Author ID: 805452
Е-mail: shurygina@rambler.ru

Information about support in the form of grants, equipment, medications

The research was carried out in accordance with the research plan of Irkutsk Scientific Centre of Surgery and Traumatology (state registration number – 122022200212-6). The authors did not receive financial support from manufacturers of medicines and medical equipment

Conflicts of interest: No conflict

Address for correspondence:

Chepurnykh Elena Evgenievna
Candidate of Medical Sciences, Academic Secretary, Irkutsk Scientific Centre of Surgery and Traumatology; Associate Professor at the Department of Intermediate-Level Surgery, Irkutsk State Medical University

664003, Russian Federation, Irkutsk, Bortsov Revolyutsii str., 1

Tel.: +7 (914) 9530210

E-mail: chepurnikh.ee@yandex.ru


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